Transition to Practice Series: Challenges, Decision-Making and Confidence

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By: Stacy Walker, PhD, ATC

Ashley Thrasher, EdD, LAT, ATC, CSCS

The purpose of this series is to provide information about transition to practice to new Athletic Trainers and those who work with them. We hope our information will help with the transition for any new employee.

Our first post addressed the question: What is transition to practice?

The purpose of this post is to discuss 2 of the challenges new Athletic Trainers face, decision-making and confidence.

We have interviewed new Athletic Trainers regarding their experiences and feelings during their transition. The below quote speaks to the challenges new Athletic Trainers face when transitioning.

“I would have to say it’s the decision making.  Being in charge.  Not that I don’t enjoy that role, it’s just that it’s a little bit of a reality check.  It’s a little more frightening that I’m the one making the decisions. [In undergraduate] there was always someone over my shoulder and you know, even though it seemed annoying at the time it was like a security blanket.”

The participants felt they were knowledgeable. However, they reported that during their bachelor’s and master’s level education, they never had the opportunity to make the final decision regarding patient care.  Final decisions were made by the preceptor, especially decisions related to return to play.  As new ATs made the transition, they were anxious about having the ultimate authority to make decisions.  Confidence was also a challenge because they hadn’t made many decisions, were unsure of themselves and often second-guessed themselves.  They were not very confident in making the final decision.

Believe it or not, this challenge is prevalent with novice healthcare providers.1-3 Educational preparation can only provide so many opportunities and situations from which the new clinician can draw.  Between being placed in a new environment with new people, policies and cultures and being in a new situation, such as working with an upset parent or coach, a novice clinician has no working memory to draw from during that situation.  Some research on nurses, for example, suggests that new nurses be placed in less complex decision-making clinical placements at the beginning of their new employment because of their difficulty with making decisions.1,3

So what does this mean for new Athletic Trainers?  They should know they are not alone in these feelings of second guessing themselves.  Many new healthcare professionals experience these same feelings when they make independent decisions for the first time.  Supervisors of graduate assistant Athletic Trainers have acknowledged that new Athletic Trainers have the knowledge; they just need to gain confidence in their decisions.4

“Having moments where I’m right has helped me develop confidence. Being able to make a decision and go out on a limb, and for my treatment or for my diagnosis to be accurate,  I think that has really impacted my confidence."

While the transition is difficult and making the decision independently is challenging for new Athletic Trainers, making decisions helps increase confidence.

There are many ways to support employees during this transition.  This topic will be addressed in future iterations of this series.


1. Dyess SM, Sherman RO. The first year of practice: new graduate nurses'' transition and learning needs. J Contin Educ Nurs. 2009;40(9):403-10.

2. Kaddoura MA. New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning, and confidences. J Contin Educ Nurse. 2010;41(11):506-516.

3. Phillips C, Kenny A, Esterman A, Smith C. A secondary data analysis examining the needs of graduate nurses in their transition to a new role. Nurse Educ Pract. 2014;14(2):106-11.

4. Thrasher, AB, Walker, SE, Hankemeier, DA, Pitney, WA. Supervising athletic trainers perceptions of preparation of graduate assistant athletic trainers in the collegiate setting. Athl Train Educ J. In press.

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